See A list of benzo-wise doctors for withdrawal from benzodiazepines. (This list may contain some entries that are out of date, but has been added to recently. These doctors may also grasp tapering of other drugs.)

Safe Harbor's list. Look for MDs and DOs, who can prescribe. The physicians, who take an integrative approach, have volunteered their contact information and generally answer the question "Help take patients off of psychiatric drugs?" with "Yes." This list is a little difficult to use, you may need to look at it page by page.

The doctors below have shown concern and knowledge for slow tapering off antidepressants and indicated willingness to work with patients on treatment plans including non-drug treatments. Follow the links next to a doctor's name for more detail about a doctor. This list is frequently updated.

If you do not wish to take any other psychiatric medications after quitting, they should respect your wishes. If you find they do not, please let us know and we will remove them from this list.

If you consult any of these providers, please let us know your experience.

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Altostrata

Altostrata

I've been corresponding with Dr. David Allen, a psychiatrist in Bartlett, Tennessee, phone number 901-384-8040. He sees patients at his private office one day a week. He has retired as a professor in the Department of Psychiatry, University of Tennessee.

Dr. Allen, a frequent commenter on various psychiatry blogs, seems to be very responsible about using medications. He says he frequently gets patients who are overmedicated and reduces their medications to the minimum. He sees through pharma hype.

He believes patients generally should take antidepressants for only 6 months.

He is skilled at tapering people off medications. Depending on the situation, he uses a 25% initial decrease but watches closely -- responding quickly to telephone messages -- for withdrawal symptoms. He will reinstate and taper more slowly from that point.

(I've asked him what the rate of withdrawal symptoms is from this initial rate of taper -- how many people he needs to reinstate and taper more slowly -- but he couldn't make an estimate. He says it's not common. He believes Paxil is the worst offender.)

This blog covers mental health, drugs and psychotherapy with an emphasis on the role of family dysfunction in personality problems. It discusses how family systems issues have been denigrated in psychiatry in favor of a disease model for everything by a combination of greedy pharmaceutical and managed care insurance companies, naïve and corrupt experts, twisted science, and desperate parents who want to believe that their children have a brain disease to avoid an overwhelming sense of guilt.

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compsports

compsports

David Allen is one of the good guys. I've been a silent admirer of his for a while. If only he were my psychiatrist so many years ago! Good to hear you're corresponding with him, Alto.

I don't think he is horrible and that is good he understands withdrawal although he doesn't seem to realize that there is protracted withdrawal. I have just never had as favorable an impression. He still drinks too much of the cool-aid in the my opinion. See his latest blog entry.

"I pretty much agree with all the points made in these comments, and I am extremely disappointed in Angell, because she has in the past discussed what is going on between Pharma and academia and raised many valid points. When it comes to psychiatry, though, she knows nothing. Antidepressants are among the most effective drugs in all of medicine. "

He also is very critical of Bob Whitaker's book.

Still Cine, I agree with your that him being my psychiatrist would have made a big difference in my life also. I wouldn't have been on meds for all those years.

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Altostrata

Altostrata

We have to take good doctors where we can find them. What I'm looking for is doctors who are sensible about tapering, not theoretical orthodoxy.

Dr. Allen is a gracious correspondent, and seems genuinely concerned about his patients, who tend to be bipolar. He's a specialist in that area. For all I know, they may be truly bipolar and helped by antidepressants. He's not a big fan of polypharmacy, which is a plus, and in his own way quite critical of pharma.

Now, how many antidepressant enthusiasts do we know who advise taking them for only 6 months? Dr. Giovanni Fava would be proud to hear this (although he's saying 3 months now).

Summary: go slow, much slower than you would have thought necessary; and of course, not without your prescriber's direct involvement.

B. Guidelines on how to get off antidepressants

1. Educate/prepare the patient well ahead of time and repeatedly.

2. Chart GAF scores [a psychiatric standard, Global Assessment of Function, a single number summarizing how you're doing] over time. Sometimes getting off anti-depressants isn’t the right thing to do and can be used to identify “Sweet Spot” for dosing. For example, I recently had a patient who was doing poorly on 300 Effexor XR started when she was still “unipolar”. Took two years to wean off. Retrospectively I was able to see that she was doing best around 75mg. Charting the GAF at appointments and the Lowest in between is best.

3. If the patient stops them AMA [against medical advice] abruptly and they are doing well then leave them off. Watch for manic symptoms. (Sometimes patients get better despite our best efforts.)

4. If the patient stops them AMA abruptly and they are doing worse don’t jump back up to the whole dose. The longer they were at the lower without feeling bad before felling worse, the lower dose you can return to. You can sometimes use half-lives to calculate this. Calculate the dose based on when they started feeling bad. Watch patients very closely during this time, even daily by phone or at the office.

5. Warn patients that they will have mood swings if they do this. Warn patients that they will have mood swings if they don’t do this, probably worse. Warn them of this over and over again. The point is to try and stop them from major panic when they do have a down.

6. Slowly is best. The slower the better. I usually wait ... at least 6 – 8 weeks between dosage decreases. Prozac/fluoxetine can be an exception to this.

7. Longer if anxiety is a major feature.

8. Faster if they feel better as they decrease dose.

9. Longer if they have difficulty with dosage decreases.

10. Longer if they are doing relatively well.

11. Never decrease before a major event or holiday.

12. Avoid decreasing during times of major stress.

13. The pt can take longer if they want to take longer for any reason.

14. Reduce in the smallest possible increments. As you approach zero then take the dose changes smaller or longer. Get out that pill cutter. If you can’t get dosage changes in small enough changes do every other day between the smaller dose and the larger dose. You would be surprised how often this works even on very short half-life drugs like Effexor XR.

15. You can go faster if they feel better as they decrease dose, but not too fast. Look for signs and symptoms of mania as well as depression. I have seen both hypomania and even mania in a [patient with Bipolar II] who stopped their antidepressant without taper. This has been reported in the literature as well. Going down slowly also avoids manic reactions

C. Special Rules:

1. Effexor XR. If the pt can tolerate doing this then this is by far the best way to do this. Open up the capsule and take one more bead out each day. Rules 11 – 13 of how to get off antidepressants apply. Pour the beads out on a creased piece of paper and count out the correct amount of beads. Then using the crease of the paper to get the beads back in the capsule. [in my town I have the advantage of a compounding pharmacist who can make small doses from the patient's large doses and allow us to decrease

2. If pts can’t count beads or don’t want to do this then take out about ¼ capsule for 6 – 8 weeks and repeat.

3. For any anti-depressant you can add in 20 mg of Prozac, get them off the anti-depressant, then taper the Prozac.

4. Prozac is a special case because of its long half-life. I generally will drop of one day at a time when reducing dose, e.g. decrease to 6/7 days a week for 6- 8 weeks then decrease to 5/7 days a week. Prozac is also a good candidate for every other day decreases, e.g. from a dose of 40mg a day go to 20 alternating with 40 mgs a day [to make a 30 mg-equivalent dose].

Note: I disagree with the info on Dr. Phelps's site describing the biologic basis of mood disorders; please don't send me outraged pms and e-mails.

07/26/12 Note: Drs. Phelps and Kelly are skilled at using lamotrigine (Lamictal) to treat adverse symptoms of antidepressants. (They may wish to call this bipolar disorder, respectfully decline the label if you don't agree.)

It's a residential facility, quite expensive: $12,500 a month. It sounds very pleasant. One location is a farm and the other is in Asheville.

My guess is you might be able to stay for a month or two, get your tapering instructions, and then leave.

Their intention is to rehabilitate psychiatric patients with minimal usage of drugs. I spoke to Debbie there on the phone and she said they've seen people who are misdiagnosed and overmedicated. In those cases, they taper people off medication.

Robert Whitaker is one of their allies.

My guess is one might be able to stay for a month or two, get tapering instructions, and then leave.

The phone number at CooperRiis is (800) 957-5155, email: info@CooperRiis.org.

Dr. Paris takes a range of insurance plans. She told me she will work with people over the phone.

She's supported me in withdrawal syndrome for more than 4 years and understands it as well as anybody. She lost part of her brain to a tumor when she was 15 and has to deal with chronic symptoms all her life. She's personally found Buddhist meditation to be very helpful.

I've found her to be extraordinarily supportive emotionally. Her approach is eclectic and existential.

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alexjuice

alexjuice

I just got an email from an old copatient in a psych clinic who went on to spend 6 months at cooperriis. He had a negative report. He believed he was removed too quickly from his opiate sub suboxone, though this may have occurred at the first psych clinic and not cooperriis. However his chief complaint was that he was forced to work 6 hrs a day at manual farm labor which he said he was not physically capable of, he has ulcerative colitis. So he was outcast more or less and simply left to fend for himself.

His case may be special in that he has a bad scale of colitis. He is over six feet and weighs like 135 pounds. In any event he said he had a bad experience though he did say he met a girl with whom he had a physical relationship and that this was a positive.

Alex

Ps - of course he was not there to taper ADs. Still I thought I would pass along the gist of his feedback. He was a former Yale undergrad who got sick got a drug problem and now lives in Russia where he had his sixth surgery last week to alleviate his colitis symptoms. Good guy. Surprisingly bad chess player...

It's a residential facility, quite expensive: $12,500 a month. It sounds very pleasant. One location is a farm and the other is in Asheville.

My guess is you might be able to stay for a month or two, get your tapering instructions, and then leave.

Do I read it right that the fee is twelve thousand dollars for a month? I think very, very few people can afford that, and surely not when one has lost his job due to w/d. Also I wonder what they can do in one or a few months time, while we know that there is no shortcut to w/d. Only the people who are still onthe drug or just so shortly off that they can reinstate will be able to get the right advice for tapering, but that is not worth tens of thousands of bugs I think.

I do not live in the USA but still think of consulting a doctor if the still very bad w/d symptoms really does not go away in the upcoming 1-2 years. Though I still postone it, one day a desicion should be made to stay off all drugs and be disabled for work for indefintite time, or treat it in an experimental way by a doctor who at least does recongize the problem. I tend to consider 6 years as the ultimate time for waiting it out.

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Barbarannamated

Barbarannamated

Alto, do you have specific questions or methods to differentiate btwn docs who are aware of a problem and sympathetic and those who may have just mild grasp of the complexity?

I know we touched on the endocrine issues awhile back. I did not find one MD who would offer any thoughts, even theoretical, on which tests will show primary endocrine problems and not yield false positives or values masked by the presence, exposure to or withdrawal from ADs. I didn't word it quite like that, but the answer was always the same: not a clue. My next question is 'what are we going to do with the results of the tests?' I personally believe that is an appropriate question before any testing or scans except to establish baseline.

All to say, if they don't acknowledge endocrine involvement, they don't grasp the big picture. IMHO

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Barbarannamated

Barbarannamated

No, Barb, grasping endocrine involvement is not the litmus test. Even those who get it about gradual tapering will hesitate to ascribe symptoms to endocrines.

Many doctors will say they understand withdrawal symptoms, even if they don't, because they ascribe it to "all in the head."

You need to ascertain their tapering techniques.

Stick to basics?

What causes some docs to 'get it', in your opinion and experience?

EX: the doc Crocus saw at Kaiser read Anatomy of Epidemic and, I believe, also had a nurse who had or was DCing. Why would an MD consider reading about medicine as written by a journalist? Just for the record or anyone who might not be familiar, I believe Robert Whitaker has a grasp on the data and science far beyond most in medicine. I report from personal experience in my family... it is very disturbing for a physician to realize that they have blindly accepted data that has been severely manipulated.

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Skyler

Skyler

Good doc..Denis Moonan, MD1515 Smith StreetProvidence, RI 02911Dr. Moonan's specialty is geriatrics, but don't let this scare you away.. docs in the area are usually good listeners. He also trained as a pathologist, so is up on the chemistry end as well.

NOTE 10/20/13: Dr. Moonan is in poor health and not taking any more patients.

Edited October 20, 2013 by Altostrataupdated

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Skyler

Skyler

LOL.. he listens to me and prescribes what I need to taper. I've given Dr. Moonan, who I call Dr. M., detailed printouts.. some of which he has read, others probably not so much. Dr. Moonan is a hospice doctor, so is familiar with many of the issues. My taper has been a 24 month odyssey and he has been there all the way. Sigh... now for the lyrica.

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Altostrata

Altostrata

Dr. Stuart Shipko has agreed to be listed as a doctor who will help patients weaning off psychiatric medications.

He says most of his practice is doing this.

Dr. Shipko is extremely cautious but also extremely knowledgeable. He has an extensive informed consent process: He will make sure you know that there are no easy answers, and outcomes are variable. He will want you to be fully informed about whatever decision you make.

He is no longer certifying disability, but with your permission, he can share his diagnosis with other doctors who can do the paperwork.

He has expressed a great deal of outrage about overdrugging and doctors' blindness to adverse effects.

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Altostrata

Altostrata

His taper rates may well be suited to the average person -- most do not have extensive difficulty reducing dosage. His books also exhaustively explain withdrawal symptoms and to updose or slow tapering if they occur.

If doctors read his books and absorbed even a quarter of the advice in them, we'd all be a lot better off.

I don't know if he's taking private patients. If someone could contact him and see if he'd agree to be listed in this topic, I'd appreciate it!

He has contributed this bio: “Dr Robert Lefever has retired from general medical practice in order to focus on his work with addiction and depression. He considers that anti-depressants are highly addictive drugs in people who have an addictive nature.”

(I disagree with this; one need not have an "addictive nature" to become physically dependent on psychiatric drugs. This indicates Dr. Lefever will address what he considers to be the psychological basis of your withdrawal symptoms.)

Dr. Lefever now offers counseling only. He does not write prescriptions for tapering. He will refer patients to private doctors nearby who will assist individualized tapering. He is not reimbursed by NHS and neither are the doctors to whom he refers patients.

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Rhiannon

Rhiannon

My doctor in The Dalles, Oregon is supportive of slow tapers and uses alternative nondrug treatments whenever possible. (She's fully trained in Ayurvedic medicine but also an MD.) She's not a specialist in drug tapering, though. But she refills my prescriptions and is encouraging and frequently tells me she's pleased with my progress and proud of me (and you see how slowly I'm going, but I get no pressure at all from her to go faster).

So I don't know if you want to add her to the list, but for sure if anyone in the Columbia Gorge area needs a doc who will support a slow taper, I'd recommend this lady. Her name's Prachi Garodia.

Dr. London is an integrative psychiatrist who is familiar with the Prozac switch and many other tapering techniques. She writes:

I would be happy to be described as a psychiatrist who is skillful in slow tapers of AD's and handling discontinuation syndromes and would be comfortable supporting anyone who wants help coming off these drugs. I follow something very similiar to the Ashton Protocol for long term users of benzodiazepines. I am also trained in acupuncture by Joseph Helms, MD and use supplements and diet as well as some very powerful cognitive and meditative practices. Please feel free to list me.